Left Ventricular Assist Device Therapy for Advanced Heart Failure – the Sheba experience

Objective: The goal of this study is to present our experience with and to evaluate the outcome of patients following left ventricular assist device (LVAD) implantation at the Sheba Medical Center.

Methods: This is a retrospective study that includes all advanced heart failure (HF) patients who received continuous flow LVAD at our institution as a bridge to heart transplantation (BTT) or as a destination therapy (DT). Outcome was assessed by survival with LVAD support until heart transplantation or all-cause mortality.

Results: The study cohort consisted of 54 patients (87% males) who underwent LVAD implantation (46 [85%] HeartMate II and 8 [15%] HVAD), as BTT (85%) or DT (15%). Mean age at the time of implant was 51±15 years. Most of the patients were severely symptomatic (INTERMACS Profile 1 or 2 (69%)). Short term mortality during the first 30 days post LVAD surgery was 17% (9 patients, 8 of them at INTERMACS profile 1). The most common post-operative complication was right ventricular failure and sepsis. The mean and median follow-up time post-LVAD implantation was 389±472 and 189 days, respectively. Among 45 patients who survived the short-term post-surgery period, 22 (49%) had no LVAD-related complications during the follow-up period. The most common LVAD related complication was drive line exit wound infection (22%), GI bleeding (13%) and hemolysis due to pump thrombosis (11%). During follow up period, 18 patients underwent heart transplantation. One year survival for patients with LVAD without transplant was 81% (9 patients completed more than 2 years of follow up).

Conclusion: LVAD is a feasible and lifesaving therapy for advanced HF patients. Our results should encourage cardiologists to consider LVAD as a therapeutic option at an earlier stage of deterioration in clinical status, which along with technological developments may improve survival and reduce the incidence of LVAD related complications.